Voices of women veterans: My Life, My Story.

PURPOSE: To explore women veterans' experiences by writing short stories of their lives as part of a program, My Life, My Story (MLMS), and qualitatively analyzing the aggregate stories to identify themes, risks, and opportunities for changes in care. METHODS: We interviewed women veterans receiving care and/or working at the James J. Peters VA Medical Center in the Bronx, N.Y. Women researchers experienced in the narrative storytelling model, MLMS, wrote participants' short stories. Twenty-two stories were written, aggregated, coded, and reviewed multiple times until saturation; no new themes emerged. The researchers established trustworthiness, consistency, and credibility. RESULTS: Themes from data from the stories of women veterans included reasons for choosing a military career, military and postmilitary experiences, psychological and military sexual trauma (MST), access to mental health care and support, antiwomen/misogynistic perceptions, relationships, life after military service, experiences with VA care and services, and future goals. CONCLUSION: Women veterans have very different military and postmilitary experiences from men. Given the increasing number of women veterans who experience homelessness, MST, and posttraumatic stress disorder, providers, the healthcare community, and the public need to hear the voices of women veterans, learn about their military experiences, and redesign women veterans' healthcare to better meet their unique needs by improving supportive mental and physical health care services.

Hepatitis C virus screening at a Veterans Administration Hospital in New York City.

BACKGROUND: Asymptomatic hepatitis C virus (HCV) infection has the highest prevalence in "baby boomers" born in 1945 through 1965. New York State mandates that all persons born during this period be screened at least once for hepatitis C. LOCAL PROBLEM: Military veteran HCV screening is often missed during primary care visits. METHODS: After baseline screening, provider education with and without an HCV education dashboard of information in the Electronic Medical Record system was used to determine if screening proportions could be improved. The Chi-square and Z-test for independent proportions compared after with before education screening. The odds ratio compared after versus before screening odds. INTERVENTIONS: Two interventions were tested. One was provider education with a 30-minute lecture. The second was the lecture with addition of an HCV education computer dashboard. RESULTS: The Chi-square test and Z-test comparing the month immediately after provider education was significant for increased screening (p < .01) compared with baseline. There was a 2.04-fold (95% confidence interval, 1.31-3.20) greater odds of screening in the month after education. If two or more months went by after education, the effect of education no longer improved screening proportions. Provider education plus the use of HCV education dashboard did not improve screening from baseline to the month immediately after screening (p = .95). CONCLUSION: Provider education significantly improved HCV screening the month immediately after education, then regressed toward baseline. Adding an HCV education dashboard to education did not improve screening. To maintain elevated screening proportions, provider screening education must be reinforced on a frequent basis for sustained effect.

The Impact of Interprofessional Shared Governance and a Caring Professional Practice Model on Staff's Self-report of Caring, Workplace Engagement, and Workplace Empowerment Over Time.

OBJECTIVE: To describe the impact of the implementation of interprofessional shared governance and a caring professional practice model (Relationship-Based Care [RBC]) on the staff's self-report of caring, work engagement, and workplace empowerment over a 4-year time frame. BACKGROUND: Shared or interprofessional governance has moved mainstream within healthcare settings, particularly within agencies seeking to sustain high reliability in the offering of quality patient care services and/or interest in meeting Magnet standards or embarking upon the Pathway to Excellence. Nurse leaders report that organizations having implemented shared governance thrive, citing professional governance as key to workplace engagement and empowerment, particularly related to quality care initiatives. Transition to interprofessional shared governance structures typically takes 2 to 3 years. It is unknown whether related outcome variables are sustainable over time. METHODS: Utilizing Watson's theory of human caring and appreciative inquiry as underlying frameworks, a longitudinal, quantitative study design was employed. Interprofessional focus groups and introductory sessions were offered to inform and engage all personnel within the medical center. Motivated units were identified, professional shared governance council members elected, and unit-specific education provided. Quality improvement initiatives were facilitated within unit councils, and formal leadership programs to enhance project guidance and to support staff empowerment skills for the managers of the units that were up-and-running were provided. Preimplementation and postimplementation measurements of staff's caring, workplace engagement and work empowerment were assessed, compared, and trended across units over time. RESULTS: Only work empowerment scores among staff working within RBC units were sustainable and increased progressively and significantly over time. Work engagement levels initially rose and then stabilized over time. Caring levels remained stable despite the implementation of a caring professional practice model. Statistically significant correlations were noted between work engagement and empowerment, followed by the relationship between work engagement and caring, followed by the relationship between empowerment and caring. CONCLUSIONS: The sustainability of work empowerment is likely related to the periodic provision of education for leaders regarding leading within an empowered work environment. A stronger focus on staff caring, particularly within quality improvement initiatives, with leadership guidance, will be paramount moving forward.

Interprofessional shared governance and relationship-based care: implementation and lessons learned.

Shared decision-making has become a hot topic in healthcare. This article describes a step-by-step, 'how-to' approach to implementation of an interprofessional shared governance and relationship-based care model at a 300-bed tertiary academic medical centre in a large metropolitan area in the US and outlines the lessons learned. The project, undertaken in 'waves', encompassed inpatient and ambulatory services and has been sustained for over eight years.

The Relationship Between and Factors Influencing Staff Nurses' Perceptions of Nurse Manager Caring and Exposure to Workplace Bullying in Multiple Healthcare Settings.

OBJECTIVE: The aim of this study was to examine the relationship between, and factors influencing, staff nurse perceptions of nurse manager caring (NMC) and the perceived exposure to workplace bullying (WPB) in multiple healthcare settings. BACKGROUND: Workplace bullying is commonplace, increasing, and detrimental to the health and availability of our nursing workforce. Positive relationships between a nurse manager (NM) and staff increase staff satisfaction and reduce turnover. Still unknown, however, is whether a caring relationship between manager and staff can reduce staff nurse perception of exposure to WPB. METHODS: On the basis of Watson's theory that caring is reciprocal in nature, a descriptive correlational design was used to assess 156 staff nurses' self-report of NMC and their exposure to negative acts using the Caring Factor Survey-Caring of the Manager and the Negative Acts Questionnaire-Revised instruments. RESULTS: There is a significant inverse relationship between NMC and exposure to WPB in the nursing workplace. Gender, work environment, and a high workload influenced these findings. CONCLUSIONS: This study highlights the importance of caring leadership to reduce exposure to negative behaviors. The data lend support to the idea of educating NMs regarding the application of caring behaviors to support staff at the point of care.

Exploring and addressing faculty-to-faculty incivility: a national perspective and literature review.

This is the first-known quantitative study to measure nursing faculty perceptions of faculty-to-faculty incivility. A total of 588 nursing faculty representing 40 states in the United States participated in the study. Faculty-to-faculty incivility was perceived as a moderate to serious problem. The behaviors reported to be most uncivil included setting a coworker up to fail, making rude remarks or put-downs, and making personal attacks or threatening comments. The most frequently occurring incivilities included resisting change, failing to perform one's share of the workload, distracting others by using media devices during meetings, refusing to communicate on work-related issues, and making rude comments or put-downs. Stress and demanding workloads were two of the factors most likely to contribute to faculty-to-faculty incivility. Fear of retaliation, lack of administrative support, and lack of clear policies were cited as the top reasons for avoiding addressing the problem of incivility.

Fostering civility in nursing education and practice: nurse leader perspectives.

Incivility in healthcare can lead to unsafe working conditions, poor patient care, and increased medical costs. The authors discuss a study that examined factors that contribute to adverse working relationships between nursing education and practice, effective strategies to foster civility, essential skills to be taught in nursing education, and how education and practice can work together to foster civility in the profession.

Hospitalists: a chief nursing officer's perspective.

The hospitalist "specialty" is sweeping the inpatient setting with numbers of physicians choosing this specialty expected to exceed 20,000 by 2010. Yet, little is known about the involvement of nursing in the design, implementation, and evaluation of a hospitalist initiative. The author suggests the chief nursing officer's pivotal role in proactively encouraging the design and implementation of a hospitalist-nurse manager patient-centered care delivery model. The chief nursing officer can create an environment to foster research designed to identify outcomes from this partnership of hospitalist and clinical (nurse) manager.